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Age period cohort analysis of rheumatic heart disease in high-income countries

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Abstract

Introduction

Rheumatic heart disease is considered well-controlled in high-income countries; however, its actual trends in mortality remain unclarified. We analyzed trends in mortality from rheumatic heart disease in association with age, period, and birth cohort.

Methods

We analyzed the WHO mortality database to determine trends in mortality from rheumatic heart disease in the UK, Germany, France, Italy, Japan, Australia, USA, and Canada from 2000 to 2020. We used age-cohort-period modeling to estimate cohort and period effects. Net drift (overall annual percentage change), local drift (annual percentage change in each age group) and heterogeneity were calculated.

Results

In the most recent year, crude mortality rates and age-standardized mortality rates ranged from 1.10 in the USA to 6.17 in Germany, and 0.32 (95% CI 0.31–0.34) in Japan and 1.70 (95% CI 1.65–1.75) in Germany, respectively. During the observation period, while Germany had a constant trend in overall annual percentage change, all the other countries had significant decreasing trends (p < 0.0001, respectively). Annual percent change was not homogeneous across each group in all 8 countries (pheterogeneity < 0.0001), with 2 peaks in the younger and older age categories. In Germany, Italy, Australia, and Canada, we found increasing mortality rates among older patients. Improving period and cohort risks for rheumatic heart disease mortality were generally observed, excluding Germany where the period effect was worsening and the cohort effect was constant.

Conclusions

Mortality trends from rheumatic heart disease were decreasing in the study high-income countries except for Germany where higher mortality and two peaks in annual percentage change in younger and older age groups warrant further investigation.

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Data availability

The full dataset supporting the conclusions of this article is available at WHO mortality database, https://www.who.int/data/mortality/.

Abbreviations

APC:

Annual percentage change

FDA:

The food and drug administration

RHD:

Rheumatic heart disease

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Acknowledgement

We are thankful for the data publicly made available by WHO. We are solely responsible to the analyses, interpretations, or conclusions of this publication.

Funding

None.

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Emory University School of Medicine, 1365 Clifton Rd., Suite A2202, Atlanta, GA, 30322, USA

    Makoto Hibino, Michael E. Halkos & Douglas A. Murphy

  2. Division of Cardiac Surgery, St. Michael’s Hospital, University of Toronto, 8th Floor, Bond Wing, 30 Bond St, Toronto, ON, M5B 1W8, Canada

    Makoto Hibino, Nitish K. Dhingra, Bobby Yanagawa & Subodh Verma

  3. Royal College of Surgeon in Ireland, Dublin, Ireland

    Raj Verma

  4. Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK

    Hiromi Hibino

  5. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK

    Dagfinn Aune

  6. Department of Nutrition, Bjørknes University College, Oslo, Norway

    Dagfinn Aune

  7. Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway

    Dagfinn Aune

  8. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Bobby Yanagawa & Subodh Verma

  9. Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA

    Deepak L. Bhatt

  10. Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada

    Subodh Verma

Authors
  1. Makoto Hibino
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  2. Michael E. Halkos
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  3. Douglas A. Murphy
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  4. Nitish K. Dhingra
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  5. Raj Verma
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  6. Hiromi Hibino
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  7. Dagfinn Aune
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  8. Bobby Yanagawa
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  9. Deepak L. Bhatt
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  10. Subodh Verma
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Corresponding author

Correspondence to Makoto Hibino.

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The authors declare that they have no conflict of interest to this work.

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Hibino, M., Halkos, M.E., Murphy, D.A. et al. Age period cohort analysis of rheumatic heart disease in high-income countries. Clin Res Cardiol 112, 1568–1576 (2023). https://doi.org/10.1007/s00392-023-02168-6

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  • DOI: https://doi.org/10.1007/s00392-023-02168-6

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